Oesophageal Stricture in a Puppy?

Re: Oesophageal Stricture in a Puppy?

Hannah Wynne Richards — Tue, 22 Jun 2010 09:18:55 GMT

Congratulations to all of you !!!!!!!!!!!!!!!!!

Well done

Wynne

Re: Oesophageal Stricture in a Puppy?

Kirsten Simpson — Tue, 22 Jun 2010 01:21:32 GMT

Thanks for all your advice re the op :) We did it today and it was a success. I did the IPPV and the locum vet (who had done one 5 year ago) did the op (boss wanted to do the op but buggered his back at the weekend and could barely stand!). We took pics during the op etc as it was all very exciting. The anaesthetic went well, op went well and the pup was up and looking very perky tonight and even ate and kept down a small amount of liquified a/d. All looking hopefull so far!!! Thanks again :) I'm really vaguely smug with my diagnosis. The things you remember from Uni! I do remmeber such random gubbins it has to be said.

Re: Oesophageal Stricture in a Puppy?

PATRICK MARSHALL — Sat, 19 Jun 2010 14:36:23 GMT

[quote user="Kirsten Simpson"]The owners/breeders have no insurance but I think we may be doing a thoracotomy on Monday maybe as its this or euth really.[/quote]

I have had a similar experience with a PRAA in a cocker spaniel puppy. Uninsured and unable to afford Dick White's fees.

We did it on a no-win-no-fee basis (fee much smaller than Dick's (sic)) but with his advice freely given on the matter.

Salient points were as follows:

Anaesthesia is no more difficult than a cat with a diaphragmatic rupture
Approach and closure is as in the book - but placing an oesophageal tube is helpful - have a thin, medium and thick one available ( obviously being able to bougie the oesophagus with care after sectioningh the ligament gives confidence that you have done a successful job- see below)
When you get to the exciting bit -i.e. the ligament you wish to sever - it will either be very obvious and easy to dissect out and ligate or will be not very obvious and running through the outer layers of the oesophagus and need careful dissection avoiding entering the oesophageal lumen (the oesopahgeal wall is likely to be v thin) if at all possible
Having a pair of the u-shaped forceps ( whose name I can't remember) used for elongated soft palate surgery is handy for getting round the back of the ligament rather than mosquitos or similar.
If it is not a PRAA and one of the other anomalies you are on a loser anyway
Being able to pass a medium sized catheter into the stomach after sectioning the ligament gave me confidence that we had cut the right thing. Seeing the catheter (in this case a horse urinary catheter) through the paper thin oesopahgeal wall was a bit hairy but comforting at the same time!
Post-op a chest drain was not required - but I did take the pup home for the night
It took about 3-4 months for the oesophagus to develop proper propulsive activity -so continue with postural feeding etc for some time and do not be despondent if it does not appear to be a quick fix.

I hope this is of some help - and good luck. I will offer up a little prayer to the "PRAA fairy" on your behalf.

Re: Oesophageal Stricture in a Puppy?

Ian Battersby — Fri, 18 Jun 2010 17:29:20 GMT

If eggs whites analogy does not work, my back up is have you seen ghostbusters - lots of slim or egg white type gue in that eighties masterpiece.

Have a good weekend

Ian

Re: Oesophageal Stricture in a Puppy?

Mike Martin — Fri, 18 Jun 2010 17:22:32 GMT

[quote user="Ian Battersby"]Final tip - regurg tends to contain lots of saliva - which is slimly and owners often describe material that is hard to pick up like egg whites.[/quote]

Good analogy, not heard that one. Another is like 'wall paper paste'.

Re: Oesophageal Stricture in a Puppy?

Hannah Wynne Richards — Fri, 18 Jun 2010 16:52:19 GMT

Good luck, and try not to worry about it all weekend-I know-easier said than done !!!!!!!

Wynne

Re: Oesophageal Stricture in a Puppy?

Kirsten Simpson — Fri, 18 Jun 2010 15:02:44 GMT

Hello all! Did some xrays today and some barium and it's looking like a PRAA. I have taken pics of the xrays with my phone but they aren't the best quality, will try and get a copy of them from work (digital) to show you guys and see what you think. A mild megaoesophagus was visible in the plain thoracic radiographs and this was confirmed with the barium and there was a dramatic narrowing around the heart base. Have had a confab with the other 2 vets at work and they think it is one as well (one has done surgery on one before and it did very well). The owners/breeders have no insurance but I think we may be doing a thoracotomy on Monday maybe as its this or euth really.

Re: Oesophageal Stricture in a Puppy?

Ian Battersby — Fri, 18 Jun 2010 14:50:11 GMT

HI Kirsten,

Agree with the posts above that plain thoracic radiographs should be the first step. Sedation can sometime cause air to accumulate in the oesphagus. Making interpretation difficult. The other concern with sedation would be aspiration if material is pooled in the oesphagus

You are right as the texture of foods change congential problems can become more obvious and it is possible his litter mates were helping to clear up things as well!

The main differentials at this point would be congential megaoesphagus and Vascular ring. Hiatial hernia is also a possibility. The later are more challenging to diagnose. Some are very obvious with the stomach herniated into the chest , but the sliding ones can be tricky to demonstrate even with fluroscopic swallowing studies. There are a few more unuusal things but those 3 are most likely given what you have described. A HH could also result in clinical signs that look like vomiting and regurg

If i am unsure whether vomiting or regurgitation. If the events occur that frequently i will admit for observation or get a video. Although if you are unsure always best to check no MO and do an x ray.

Final tip - regurg tends to contain lots of saliva - which is slimly and owners often describe material that is hard to pick up like egg whites.

Re treatment - with congenital MO largely elevated feeding and fingers crossed. but they dont tend to do well.Vascular ring - not a surgeon so wouldn't like to comment on how easy they are but you would have to be very sure of your anatomy and your diagnosis and if possible have angiography ( ideally CT angiography) incase this is a more unusual vascular anolomy . With a hitial hernia some of the less severe cases can be managed medically with antacids and low fat food.

all the best and would be interested to hear how you get on

Ian

Re: Oesophageal Stricture in a Puppy?

Mike Martin — Fri, 18 Jun 2010 09:52:54 GMT

Coincidentally, in our latest Newsletter, we have an Barium swallowing image taken from a fluoro, showing a hiatal hernia in a dog. http://www.vetsurgeon.org/members/Mike/files/Martin-Referrals-Newsletter_5F00_summer2010.pdf.aspx

In this case, I would start with a plain (conscious) lateral radiograph, to check for a megaoesohoagus (as others have suggested) before feeding it a Barium meal.

Re: Oesophageal Stricture in a Puppy?

Peter Ding — Fri, 18 Jun 2010 08:12:03 GMT

I sincerely hope they ligated the ductus arteriosus rather than the aorta!

Over the years I've done a couple, both successful, and not something you should be afraid of. It's straightforward, if you can manage chest drains. This doesn't sound like one to me though.

But i would suggest you treat the severe gastritis first, it may be just that. Common things occur commonly and usually respond to medication.

I would save my worry for those that don't respond, and you've ruled out most other causes.

This puppy may have an intolerance to some foods.

Re: Oesophageal Stricture in a Puppy?

Michael Woodhouse — Thu, 17 Jun 2010 23:57:58 GMT

I saw practice where a practice ligated a persistent right aortic arch - anaesthetic the same as a diaphragmatic hernia. Was fiddly but dooable.

Dog was much better but still needed sloppy food fed from a hight.

Re: Oesophageal Stricture in a Puppy?

Nixthevet — Thu, 17 Jun 2010 19:28:58 GMT

Hi Kirsten,

i don't know if you are a subscriber of VetECC.com ( Vets Nows website that has forums etc similar to this)- but there is a recent post on there ( from yesterday I think) named 'thoracic catastrophy' and there are images of the x-rays of this dog- which were confirmed as a hiatal hernia. It might be useful for you to take a look as there is a bit more info on these on there too.

I'd say that surgery for PRAA depends on the surgeon and the nursing team. Obviously it requires thoracotomy and therefore very careful aneasthetic monitoring. A brave surgeon will also be required. If it's a case of you either have a go or the pup gets euthanased then i'd say you have very little to loose.

Good luck

Nichola

Re: Oesophageal Stricture in a Puppy?

Kirsten Simpson — Thu, 17 Jun 2010 18:50:08 GMT

No heart murmur. Well wormed. I haven't given it any treatment yet. It's around 10-20mins after eating that it V+, the owner says its quite white and frothy along with it and the sample it deposited in the waiting room this afternoon was pretty undigested chunks with white froth.

Hiatal hernia is a good shout. Aren't they hard to diagnose from xray?

Re: Oesophageal Stricture in a Puppy?

Peter Ding — Thu, 17 Jun 2010 17:59:06 GMT

Any heart murmur?

Well- wormed?

What medical treatment was given? Metoclop/Cerenia/acid blockers?

I would be checking for a hiatal hernia if you X ray it.

How long after eating is it vomiting the food back? Is it projectile?

Does the vomit include any yellow material, or is it as eaten?

Re: Oesophageal Stricture in a Puppy?

Gillian Mostyn — Thu, 17 Jun 2010 17:55:28 GMT

Maybe take the pH of the vomitus - should confirm whether it has been in the stomach???

Most of the (congenital) cases of persistent V+ I've seen in this age of dog have turned out to be megaoesophagus - be careful with your barium until the possibility of aspiration is ruled out.